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April 1992

Pupil-Sparing Oculomotor Palsy due to Midbrain Infarction

Author Affiliations

2900 Baltimore, Suite 320 Kansas City, MO 64108

Arch Neurol. 1992;49(4):348. doi:10.1001/archneur.1992.00530280028012

To the Editor.  ——The recent article by Breen et al1 entitled "Pupil-Sparing Oculomotor Nerve Palsy due to Midbrain Infarction" was very informative and interesting. We present another case of painless, isolated, oculomotor nerve palsy resulting from midbrain infarction to underline another important clinical point.

Report of a Case.  —A 62-year-old man presented with abrupt onset of ptosis and limitation of extraocular movements of the left side. The patient had no headache or any other neurologic symptoms associated with it. He had a previous history of congestive cardiac failure, severe coronary artery disease, and myocardial infarction, but there was no history suggestive of any previous cerebrovascular accident. The patient's examination demonstrated near complete, pupil sparing, isolated left oculomotor nerve palsy. The patient did not show any weakness in left abducent or left trochlear nerve distribution. The rest of his examination was unremarkable. The magnetic resonance imaging of his brain demonstrated

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